quality. so we think it's a very fair return. >> david, obama care is coming. how is that going to affect your company? >> we see obama care as driving change in the marketplace and change is good because maybe to your core question, the status quo is not acceptable. we need to take costs out of the system and increase quality. for us, focus more on services. the change in the marketplace is a positive. one of the biggest changes we see happening in the united states is the opportunity to partner with physicians, to collaborate with physicians, to drive increases in health quality. today we have over 50 collaboratives already up and running in the united states where physicians are more paid based on the quality of outcomes haves the quality of services. as a result, people are getting better quality of outcomes, better services and costs are coming out of the system. >> david, give us a -- your outlook for the year ahead and a little bit beyond that. to what extent, when washington is -- it's in the middle right now of the process of trying to find cost savings. do you expect some of tho
